Le diagnostic de la pose de pacemakers

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Everything there is to know about rhythmology

How did we reach a diagnosis ?

Sometimes, the diagnosis is crystal-clear/unmistakable because the symptoms are typical and correspond to obvious electrocardiographic abnormalities/defects. In that case, your attending cardiologist, or sometimes your attending physician, will indicate the implant of a pacemaker straightaway.

In some other cases, there might be symptoms without any obvious electrocardiographic translation/ evidence/manifestation. Your cardiologist will then carry out further examinations (continuous recording of the electrocardiogram for instance) which might be enough to bring to light the necessity of a pacemaker.

In some rare cases, you have to push things and be hospitalized for 48h. An electrophysiological exploration and an test d'inclinaison will then be carried out (see.). If all the results are/ the whole checkup is negative, and the clinical signs are typical, we might suggest the patient to have a Holter implantable set in.

Passive leads

How does the equipment function?

A pacemaker is made up of two parts:

- The first one is that which will generate the electrical impulse. It is an airtight and watertight metallic box made out of titanium. It holds the energy source (Lithium-Iodide battery) and the pacemaker's functioning software/program. That is the part you can feel under your skin. When your heart slows down or stops, the box is sent information through the lead. It sends electrical impulses which drive the heart to its set frequency.
- The second part is that which guides the electricity all the way to the heart. It is the stimulation lead which is made up of one or several electrical conductors, set within a biocompatible insulating material. The distal tip of the lead (electrode) is sometimes used to detect spontaneous cardiac contractions and stimulate the heart if need be.

To set the leads in the heart, there are two methods. The leads can be "passive" because they passively set themselves thanks to the development of fibrosis around the barbs that you find at their tip. The leads can also be "active" because the surgeon has a screw come out of the lead's distal tip; the screw then penetrates the cardiac muscle. The choice of one or the other depends on the surgeon's habits and the choice of the stimulation site.

Active lead with screw

Are there several types of pacemaker?

Pacemakers are divided into three categories:
- the simplest one is the "monochamber" pacemaker: monochamber means that one lead will stimulate a single cavity (atrium or ventricle).The choice of the cavity depends on the conductive disorder.
- The dual chamber pacemaker stimulates two cavities (atrium and ventricle). It is the most implanted because it integrates best within the cardiac physiology.
- Finally, some centers implant "triple chamber" pacemakers. Unlike the two others, this technique doesn't target patients presenting conduction disorders. Schematically, it is prescribed to patients with cardiac insufficiency where there is a desynchronization between the left and right part of the left ventricle.

Read more: How do we implant the equipment?

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